GASTROINTESTINAL AND OESOPHAGEAL STENTING
What is stenting?
Stenting is the placement of a stent inside your body. A stent is a mesh tube made out of metal which can be inserted into a passage in the body (such as a vein) to act as a skeleton and keep it open. You may be advised to have a stent placed if you have a blockage in your gullet or bowel which is caused by a tumour.
Symptoms of a blockage in the gullet, stomach or small intestine include being unable to consume an adequate amount of food, nausea and vomiting. If you have a blockage in your large intestine you may find it difficult to go to the toilet.
A stent may also be used to keep a fistula open, which is a connection between the gastrointestinal tract and the organs or tissues around it.
How does the procedure work?
Before the procedure, the interventional radiologist will outline the obstruction with contrast material under X-ray. You will have a local anaesthetic in your throat and be under mild sedation for the procedure. The interventional radiologist will introduce a device containing a wire and a catheter through your mouth and to the blockage in your gullet or small intestine. After the narrowing has been reached with the wire, a tiny balloon will be introduced and will slowly expand to dilate the area around the blockage.
Once the area has expanded enough, the interventional radiologist will implant the stent to bridge the blocked segment and keep it open. Sometimes a second dilation with a balloon is needed to help the stent expand better.
If the blockage is in your large intestine, the procedure will be performed through your anus, but otherwise the steps will be identical.
If you are being treated for a fistula, a stent covered with a membrane will be placed across the fistula before the procedure to protect it from the contents of the intestines.
Why perform it?
The aim of stenting for blockages in the gullet caused by a tumour is palliation, meaning the procedure is carried out to relieve any symptoms or pain caused by the blockage. Your symptoms should be relieved after the procedure and you will be able to eat normally again.
If you have an acute obstruction in your large intestine, meaning the blockage must be treated straight away, you may be advised to have this procedure as a bridge to surgery. This means you can choose to have the necessary operation later and avoid the risk of emergency surgery.
If you have a fistula, this procedure will protect it from the contents of your intestines and will allow the fistula to seal over time.
Benefits of IR guided procedures
101. Rapid relief from symptoms.
102. The imaging techniques allow accurate diagnosis and treatment using cutting-edge equipment. Diagnosis is reconfirmed during procedure.
103. Minimally invasive procedures are performed through a small hole in the skin, minimising the patient’s discomfort and recovery time. There won’t be any scar.
104. Most procedures can be performed on an outpatient basis or require only a short hospital stay. As interventional procedures tend to require only local anaesthesia, hospital stays are very short, with patients frequently going home the day the procedure is performed.
105. Patients who undergo IR procedures experience less pain during and after the procedure than patients undergoing surgical procedures. Post-procedural care is provided, along with follow-up imaging to confirm if the treatment has been successful.
106. Minimal damage to surrounding vital anatomical structures with no significant structural weakness.
107. No or negligible blood loss. No requirement of blood transfusion.
108. Return to work and other normal activities usually within the first few days after the procedure.
109. Low risk compared to surgery. The techniques can be used in very sick patients who are unfit for surgery.
110. Overall procedure is less expensive than surgery or other alternatives.
How will you prepare for procedure:
Procedure will be done as a day case procedure, only rarely would you need to stay overnight.
• You will have had some blood tests performed before the procedure to check that you do not have an increased risk of bleeding.
• You are asked not to eat for 4 hours prior to the procedure. You may drink a little water.
• You will need someone to drive you home and to look after you for 24 hours.
• You should be prepared to stay overnight if necessary.
• If you have any allergies or you have previously reacted to intravenous contrast medium, you must let the doctor know. Intravenous contrast medium is the injection we give you during some scans.
• If you are diabetic, please contact IR coordinator at 0328 0177770 for further information
• If you normally take any medication to thin your blood (anticoagulation or antiplatelet drugs) such as: warfarin / clopidogrel / aspirin, dabigatran (Pradaxa) / rivaroxiban (Xarelto) / Apixaban (Eliquis) / phendione / acenocoumarol – then these may need to be stopped or altered. Please contact the contact IR coordinator at 0328 0177770 for further information
How long will it take?
Every case is different, and it is difficult to predict exact time it will take. Procedure will be carried out in image guidance and roughly takes an hour or so.
What Happens afterwards?
You will be observed in a post operative facility for 2 to 4 hrs and if all observations are satisfactory, you will be discharged home the same day. It is natural to feel tired after the procedure and a light bed rest for a couple of days is recommended.
